Statins - miracle or menace?
 

Having had a medical hiccup it's been suggested that I should take statins (despite not having high cholesterol) on the basis that there is apparently some evidence that they are generally a "good thing". When I look around I see people saying they're dreadful, cause memory loss, and might be the cause of nearly half the world's ailments.

What's the opinion of the medical pilot community on statins? (references to back-up assertions would be good!)

The evidence for their use is strong.

Medicine generally tends not to extend life. It's got it's place when one get's mangled up on the M6, put apart from that, there are only a few occasions when it actually makes much of a difference.

Immunisations work well, the "golden hour" saves a few lives, and fiddling about with peoples blood pressure/sugar levels may make a bit of a difference.


The other stuff we spend your money on could perhaps be spent on other areas.

Statin's however, seem to save lives. The odd recipient may suffer liver problems/ muscle problems, but in reality I haven't seen much evidence of this, and nowadays, the monitoring we use, seems to pick these problems up quickly.

They do seem to have a "magical" effect that we perhaps don't understand just yet.

Should we just tip them in the water?

It's unfathomable to me why anyone would be offered statins in the absence of a lipid problem.

But I'm sure there is a segment of my profession that thinks it would be a good idea.

A dozen years ago it was conventional wisdom that hormone replacement therapy should be offered to every woman at that stage of life. How'd that work out?

Graham MD

I stopped taking statins a year ago; I feel considerably better now. Statin Drug Side Effects - Main Menu

I suspect the issue surrounds itself around the arbitrary number given to when lipids become a "problem."

In secondary prevention, (ie when you've already had your heart attack/stroke), reduction in lipid levels (irrespective of starting point) seems to reduce further events.

Primary prevention (ie preventing events in those who are otherwise healthy), does also seem to be supported by a robust body of evidence, although I'd be the first to admit that the tools designed to take into account other factors such as smoking, age, family history, blood pressure etc) are far from perfect.

But don't just take my word for it:) CG67 Lipid modification: full guideline

It seems to me, gingernut, that it's another example of pulling together a committee, then coming up with a recommendation that keeps the majority happy. So it was decided that seeing as how the downside of drug therapy is low, the threshold for treatment could be lowered. And then if you lower it enough, then everyone over 50 will have a 10 year cardiac disease risk high enough to cross the threshold.

Unfortunately history shows that in most of medicine if you think you have the final answer, it'll turn out in the future to be completely wrong. (Think "mammograms" and "PSA")

And today we are often guilty of assuming that the most recent "study" is correct, even if it negates the previous 25 studies. That's usually because the recent study was not one at all, just a "meta-analysis" (i.e. a rejiggering of the data).

Rant off. I'm late for bed!

There is good objective evidence for statins

First they reduce cholesterol in people with hi levels and this is shown to be beneficial

There ae also two large studies showing that if given to people with normal cholesterol and no increased risk factors, the death rate from strokes and heart attacks was reduced

A large multi centre study coordinated by Oxford was released two weeks ago. It not only confirmed this but also clearly showed that the only significant side effect was myalgia or muscle pains which is a condition that stops if you stop statins

Sadly people will say statins are pushed by drug companies or committees but the science speaks for itself. Of course everyone can make up their own mind and there is no compulsion to take them but it verges on the immoral to frighten people from taking them when the evidence does not support this stance

It's refreshing to meet someone as cynical as myself obsgraham. I'd agree there is never "the final answer," provided by research, and of course, we can never "prove" or "disprove" our interventions absolutely, but I think where we have moved on, is that we are using more robust evidence, relying on realistic outcome measures, (such as the Grade 1 RCT's in statin intervention), and are less likely to rely on studies of poor design, using proxy outcome measures (which don't translate to clinical benefit), or even worse "expert opinion."

A meta analysis or systematic review shouldn't automatically refute the past 25 studies, it should add collective weight to the accuracy (or innacuracy) of the previous studies.

The RCGP stuff I cited does rely on high quality studies.

The decision to offer statins to those of CVD risk of 20% or above (in 10yrs), was made by a committee- I suspect this was made on the basis of cost, rather than clinical effectiveness, and I accept,the method we use to establish the risk calculation is far from perfect. (Although better than what we had before.)

Once you've been on a statin such as Crestor for a while, the evil cholesterol levels within you will begin to decrease.
When you've been on Crestor for a long time, the furring of the arteries, caused by the previously mentioned nasty cholesterol, will slowly begin to reduce.
Something else will kill you when you least see it coming but anything which reduces the chances being a stroke victim and unable to get along to Dignitas is to be taken with relish if not tomato sauce and tabasco.

I was told my local surgery's computer had decided I should take Pravastatin. I pointed out my Cholesterol level was 3.9 so did I need it? Well I was persuaded I would benefit from its use. Since taking it my hair has fallen out at a much quicker rate than normal, I have massive muscular pains and at present have a particularly nasty intercostal muscle [right side] that has spasms that make me gasp [squeak loudly!] in pain. I am cutting down over a 4 week period and telling my doc when it is done. My arteries are apparently 'clean and clear of any clag' according to my cardio.

Onward and upward.

Get your CK (Creatine Kinase) levels checked.

CK and statin treatment - General Practice Notebook

:)

Thanks for the link to the guidance document; it isn't exactly a fun read but I got through the majority of the bits that seemed relevant. Having read the guidance I didn't feel convinced that the evidence was sufficiently strong for someone with "normal" cholesterol levels to risk the side effects (documented in spacedoc.com, gpnotebook and elsewhere), especially as the reported beneficial mechanism for this group seems not to be fully understood.

Maybe this is a case of a (very) little knowledge being a dangerous thing, but ... I was confused by a couple of statements in the GPnotebook guidance: "It is hypothesised that there are two types of atherosclerotic lesions: atherotic (soft, lipid rich, there is often inflammation which destabilises the plaque's fibrous cap, the risk of plaque rupture makes these dangerous) and sclerotic (hard, collagen-rich, these are safe). The statin family of drugs alters the characteristics of the lipid core and reduces inflammation. The fibrous cap is stabilised preventing rupture. The total volume of the plaque may remain unchanged." Yet it also says: "... however, no statistically significant differences were seen for cardiovascular mortality or stroke". Elsewhere I've read that a rupturing atherosclerotic lesion can lead to stroke so if the hypothesis about statins stabilising the lesion is correct why has no significant improvement in stroke rate been seen?

hugh flung, it's a little difficult to give specific advice to someone via this forum.

I'm imagining that you've been prescribed pravastatin for a very good reason, (ie you've suffered some type of "event" already), as pravastatin isn't generlly used in primary prevention. It is important that you communicate your concerns to your docs.

My comment about pouring the stuff in the water does have to be taken with a pinch of salt, statins have been associated with serious side effects, muscle damage and liver damage being the ones that spring to mind.

I'm involved with statin prescribing/monitoring on a daily basis, and whilst I've seen the benefits of statin prescribing, (ie less people dropping dead or becoming disabled through stroke and heart disease), I don't think I've ever come across a case of statin induced muscle damage or liver problems.

Having said that, it is important to differentiate between a side effect, (eg aching legs) and disease (eg rhabdomyolysis), and your clinician should, hopefully have monitoring systems in place to detect these.

I haven't the expertise to answer your question about the nature of the atherosclerosis, but in a way, it's of secondary importance, as the outcome (ie reduction of risk of further "event") is more important than the process behind it. (We know it works, were not quite sure how.)

Statin use does prevent stroke. CVA and lipids - General Practice Notebook

As ever, patient choice reigns, its our job to give the facts as accurately as we can given the knowledge we have at the time. (It may all change again next week!).

Good health,

ginge.:)

Thanks gingernut. To be clear: I'm not looking for advice (just to understood what's on each side of the risk/benefit balance) and I haven't been prescribed anything (it's been suggested that a statin might be beneficial, despite not having high cholesterol levels).
That link is very positive about the benefits of statins but the NICE guidance - statins for the prevention of cardiovascular events says "for patients without clinical evidence of CHD, statins significantly reduced all-cause mortality ... however, no statistically significant differences were seen for cardiovascular mortality or stroke". To a medical layman this seems to be at odds with the guidance in the "CVA and Lipids" guidance - what have I missed?
If there isn't a known mechanism, and the stats don't show any significant differences, then what's the compelling evidence that justifies the risk of even minor side effects?

HFD

"primary prevention for patients without clinical evidence of CHD, statins significantly reduced all-cause mortality, fatal MI and non-fatal MI in the meta-analysis carried out for the NICE appraisal however, no statistically significant differences were seen for cardiovascular mortality or stroke" Yes, it seems a confusing stance. As far as I can gather, statistical significance concerns itself with academic "proof" (ie more than 95% sure of certainty-or more technically, less than 5% percent of innacuracy), whereas the bottom line revolves around "clinical significance," ie the ability to to do what it says on the tin. It works the other way round as well. I once looked at some statistics around smoking cessation-the intervention showed a statistically significant difference in the number of cig's smoked-when we looked at this in more detail, the amount of cig's smoked was reduced from 20 a day, to 18. Statistically significant-yes, clinically significant-no. (in other words, the cig's will still kill you.) I think I've got the correct end of the stick, there's a really good BMJ book that can probably explain things better than me, or perhaps an Academic would care to step into the breach :-) It's important to note that the statement concerns itself with chd/cva MORTALITY only. I'm wondering if it means "no proof of effect" or "proof of no effect" (Very different things.) Notably, statins reduce "all cause" mortality, and I'm assuming, chd/cva MORBIDITY, which I guess is the ultimate bottom line.

Thanks for the questionning, it's good to shake around the grey matter.

As you correctly surmised, ginge, I am a true cynic. And somewhat of a therapeutic nihilist.

My concern on this issue is that, faced with potential cost savings by encouraging widening use of statins, the boffins will tend to cherry-pick the statistics to support their agenda. That's why I am skeptical of our current love of meta-analysis. Mr. Dung quite accurately picked up on the deficiency in the mortality question.

And, as we've often pointed out, mortality still remains at 100%.

I had to google nihilist, and I'm not quite sure I understand it still, but I guess we are probably p*ssing in the same bucket. (A Manchester term.)

Definition of a pessimist?

An experienced optimist:)


time for bo bo's.:p

Well, Ginge, you know, I do come by my cynicism honestly.

I was, after all, born in Preston!

**: Therapeutic nihilist: one who thinks doing nothing is often as good or better than doing something. Especially involving pharmaceuticals. And some kinds of cancer.

Saw my doc who looked at my records [over the last ten years my cholesterol level has been in the lower half of acceptable levels and as I have atrial fibrillation and can no longer fly [bugger!] and am taking a series of drugs to help the AF he has stopped the statin intake. :)

And that good mate of mine, diagnosed with Diabetes type 2, prescribed statins wound up in dreadful pain (lower lumbar region), pissing tar coloured urine ,investigated for all sorts of other things like kidneystones, took action himself & threw the damned medication down the toilet. He has never felt better, looked better & has little to recommend the medical profession. Oh, he once worked as a Medical Sales Rep & knows the inducements offered to GP's by the pharmaceutical giants. we have to suffer this lot every six months & they have the power to wrongfully diagnose, wrongfully prescribe dangerous drugs & potentially wreck the professional careers of pilots. For my other mate, having passed his Class One Medical (enhanced requirement as he was over the age of 60), wound up in ICU with double kidney failure just weeks later. Oh, he died.

Slowjet

You obviously have been close to people who have had medical problems and may or may not be justified in blaming doctors. Doctors make mistakes just like pilots. However, you are not justified in claiming nonsense about the pharmaceutical industry inducing GPs. This stopped over 20 years ago. Drug companies can't give doctors anything now. I am not a GP but such abject rubbish does your argument no credit

Ok, this is a challenge to any of homonculus's patients. I bet there is some drug company reference somewhere in his or her office. (Look at the clock, everyone's got a Lisinopril clock.)

All joking apart, the inducements to GP's are probably few and far between, the Medicines Management Gestapo regulate this sort of thing robustly. I suspect it's still more of a problem in secondary care, loss leaders still seem to filter down to us in primary care-(who usually take on the role of life long prescribing.)

Although bodies such as NICE and the other quango's that have gone bust get knocked, they were initially very effective at spending tax payers on interventions which improved health. (They got a bit wooly in the end though.)

Oh well, time to strengthen 'me teeth with having a glass of flouridated water. (Bloody mass medicators.)

Statin Drugs - NO!!
 

Hi

Your number one priority in life while being on any kind of chronic subscription medicine should be to get off from it. Do not take the statin drugs, it is bad sceince and any doctor prescribing you statins have already given up on you!

The medicine will eventually stuff up your biochemistry i.e. "side effects"...you can easily and 100% take care of your health the natural way with no side effects...period!

"I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect"...taken from the Hippocratic Oath.
I am amazed how doctor's do not apply this oath.
The word "money" and ignorance rings a bell.

Air Traffic Controller
Massive heart attack in 2007, 3 stents
Completely off "Western Medicine" since Dec 2011
I only do Nutritional supplementation and lifestyle change(easy)
I have never felt so healthy since stopping all pharmaceutical and prescribed medicine!
If you want the facts and science, then speak to a Biochemist.

Blessings

Light:
First: calm down. This is a web-board, not a courtroom.

Second: If you truly believe that chicanery outweighs productivity in the regular medical fields, then you must be ignoring the vastly greater amount of deception, greed, and out-and-out quackery that goes on in the area of "alternative medicine". In the absence of any scientific methodology, you are essentially your own experimental trial.

Good luck with that.

Hi Gingernut

No no clock or pen or anything else. In secondary medicine we no longer get to meet reps and get no free lunches. The companies themselves are so strictly controlled. I not infrequently go for a social meal with reps I know via my partner and who sell products I can never even access let alone prescribe in my specialty. I have to buy them dinner as they can't be seen to buy me a meal even from their own bank account

And so Light I find your comments offensive. I practice medicine to the best of my ability based on science. I have never accepted money to prescribe a particular treatment nor indeed has it ever been offered. The suggestion that I might is below the belt and unprofessional. you may want to ignore scientific evidence obtained by blinded research from Oxford University over many years, and you are Welcome to avoid modern medicine and return to a
World where life expectancy was only 49 just a century ago. But if you want to accuse the medical profession of corruption and effectively harming patients please provide the evidence or go back to the day job

Don't forget the natural tin foil hat, light. Remember, shiny side out.

Hang on a minute there Light. I am detecting an element of hypocrisy here. First you say , and then tell us you've had a massive heart attack requiring 3 stents! Doesn't sound that your health was 100% taken care of. I'm also guessing that the stents weren't carved from hemp and inserted by a "biochemist" on the kitchen table with no anaesthetic, other drugs, or modern medical equipment!

Dear oh dear; see what we mean ? Massive fight back by the medics but showing re-action rather than careful thought. LIGHT said he had a massive heart attack in 2007. He ditched western medicine in 2011. Er, three years later (!) and has never felt better. He was also asked to calm down yet my reading indicates a very calm submission with advice & info he wishes to share.

SLOWJET referred to a colleague of his & I think I know who he is. I agree, since ditching the statins (back on thread please) he has never looked better, fitter & pisses normal urine with no blood tracings & looks set to lead a fabulous retired life in the Med.

Gingernuts, I want you for my GP . Don't need an AME as I too, just hung up my flying boots. You sound perfectly balanced and of great comfort to many, including me, on this forum. Pity that many of your colleagues head for the prescription book faster than the Lone Ranger reached for his gun.

No, not a "massive fight back" at all. The stated aim of this forum is To debate, one must take an alternate view. There have been a number of accusations bordering on the criminal bandied about here, suggesting all sorts of ludicrous conspiracies. My treatment decisions are based on evidence from properly conducted clinical trials, overlaid with the wishes of my patients.

OK, I take your point that Light ditched western medicine after it had saved his life. Lucky for hime that he didn't choose to take this path in 2006. What happens when the stents fail (as they often do)? Will he simply allow himself to die?

Of course everybody has the right to make decisions about their own health care, but they should make those decisions based on accurate and validated information.

Unless you want this thread to go the way of so many others, please get back on track. :=

Cheers,

BM

Kind words, Landflaps, for the record I am a nurse, albeit working at an advanced level.

I guess what's happening on here is a display of passion, not always a bad thing, but as Bad Medicine points out, it's about playing the ball, not the player.

My passion for this sort of thing arises from having to deal with the scourge of arteriosclerosis on a daily basis. When I started my training many moons ago, families were destroyed by diability and death, caused by strokes and heart disease, (often with the victim being about my age.)

Things seem to have changed, for the better, and there are various reasons for this-people are smoking less, eating more fruit and veg, exercising more etc, but I still reckon statin's play a large part in both primary, and secondary prevention. Systematic, organised health care has also helped.

Make no mistake, drugs companies are ruthless, and I'm one of their biggest critics, but (my) very objective observations, convince me that statin's work.

This view point may change as we discover more, but that's okay, that's the nature of the beast.

Good health.:ok:

A great post 40&80

You are right - in todays regulated medicine as Gingernut alludes to, care is reasonably standardised and 'bad' docotrs and nurses are rare. Mistakes can happen, but the main determinator for whether a patient thinks a doctor is good or not (and vice versa) is communication. Unfortunately for us doctors patients vary in their preferences. I can send 2 patients to the same consultant - one will say the doctor was arrogant / uncaring / cold and the other will say he was authoratative and didnt waste their time talking about social matters.

Interestingly, when I read your consultant's comment about the GP I took the opposite view - he was saying he liked and knew the GP and she was kind; there you go.

But back on theme - statins. In fact there is evidence statins continue to be protective for months - much longer than they remain in the bloodstream. Aspirin will reduce platelet stickiness and prevent clots for at least 10 days. So whilst they are prescribed daily, missing the odd dose is not critical.

In fact very little in medicine is - clotbusters in heart attacks reduce the long term disability and death rate in the population, and paramedic services may reduce the death rate in a very small percentage of patients, but we rarely 'save lives' - we reduce pain, treat symptoms, hopefully put some cancers into remission and overall improve your statistics so you are on the planet with a reasonable quality of life for longer. Doctors who claim they save lives somehow rile me.

Please let me indulge myself a little.

When I first came to primary care (GP land) a chap came into the corridor complaining of chest pain, and promptly collapsed. A colleague and I administered a jab of morphine, sent for the ambulance and got him seen at hospital.

Thankfully he survived. (This was before the time of using aspirin/clotbusters.) Apart from reducing the risk of cardiogenic shock, it's likely we didn't make much a difference to the outcome. He survived through luck. Ever since, he equated the jab, with the saving of his life, and every Christmas, he brought my colleague and I a bottle of whisky.

In those days, we worked as hard as we do now, but we weren't organised. The average patient would come along with his sore toe, we'd treat the sore toe, and off home he'd go, happy with his prescription of flucloxacillin. The other stuff which should have been performed, like ensuring his blood pressure was controlled, or making sure the patient had the correct blood tests, mostly fell out of the window.

We (!) decided if we could organise things better, ie positively invite the patient to come along for the tests, monitoring, treatment etc. This was aided by various mechanisms, including the way we paid GP's, (through the PMS/GMS and what eventually became QOF-paying GP's for jumping through hoops, which impacted on health outcomes), extending the scope of other professionals (eg allowing nurses to prescribe), and putting someone in charge of the whole thing, (Practice nurses were good at this.)

We (roughly) estimated, that as a result of putting these measures in place, there were 4 extra people walking around at the end of the year, that may have died of heart disease previously.

It wasn't rocket science- no new drugs, no fancy clotbusters, no millions spent on tertiary care centres, just getting things organised for our 12,000 patients.

The system was rolled across the PCT, and eventually the country. I reckon there are thousands of people walking around as a result of this systemised approach to care.

AND NOT ONE OF THE B*GGARS HAVE EVER BOUGHT ME A DRINK.:)




A simplistic view point, I'm not here to defend QOF, I've got my own reservations, just trying to make the point that in Primary Care/GP land, the work isn't always that sexy, but it does make a difference to both the quality (morbidity) and quantitiy (mortality) of our patients lives.

I'd agree with homon, communication is key to keeping the art of medicine and nursing alive.

A Question regarding Statins.......
Does life time daily Statin medication deplete Cq10 in the body to a dangerous level?...if so is it wise to supplement with CQ10 daily tablet intake?
I this is a fact... then the NHS would also I feel also have me on daily CQ10 tablets.
The truth is I have absolutely no real idea what this CQ10 is all about other than what is on the internet....the internet sales persons make it sound very important that I buy some.

CQ 10 ia a substance the worried well buy on the Internet. It is claimed to cure blood pressure, heart attacks, strokes and many other diseases. If there were a scientific basis for this we would be using in in conventional medicine. We don't. There isn't.

That is not to say many believe in it. Just that the scientists don't. Anti oxidants don't work. If they did we would all live to 100

Take five minutes to review this:

Dr. Osborne - Statin Drugs and CoQ10 Deficiency.avi - YouTube

The good doctor is not a doctor as in the term medical practitioner. He is a chiropractor in Texas.

John Travolta advertises for Quantas

Caveat emptor

I think the concern for outsiders are the large drug companies.
Looking at medicine in the future we would want "cures"! Cures for Cancer! Heart disease! etc etc etc.
Cures would not suit the big drug companies! Prescribe a drug for life and the drug companies get an income for life which is very different to selling a product which you do not need after a couple of weeks! End of income.
Those drug companies are going to protect those life long earners maybe develop drugs which are better tolerated but still life long earners.
BP tablets and Statins fill that category!
In Fact I would go further the drug companies will produce research which paints a picture they want to paint and have a massive marketing effort placed to make sure the medical world are conditioned to believe it!
I wonder how much the drug companies actually stifle medical advancement in finding proper cures as that is the very last thing they want!

The latest trend no doubt backed up by shady research is for mass medication over a set age Wonderful for the drug companies so do not be surprised that some of us are sceptical? We all know that research like statistics can be made to read what you want them to read.

Pace

I started reading Dr Duane Graveline's book 'Statin Drugs Side Effects and the Misguided War on Cholesterol'. He is one of 'ours', being a Flight Surgeon (USAF ret) and Astronaut-scientist (NASA Ret) as well as a family doctor. Cholesterol is what makes your brain and memory function. You might loose your medical very quickly if you have some of the side-effects he describes and suffered himself. Red Yeast Rice will have the same cholesterol-lowering effect but with no side-effects, if you think that cholesterol must be lowered for any reason.
I stopped taking simvastatin a year ago, I couldn't remember all the digits of a frequency given by ATC anymore, it was like one of the digits 'dropped into a hole' (short term memory lapse). The fog has now cleared and being clear of statins I am ready for more ATC frequencies and waypoints.

If I would have mentioned this memory problem to a GP he would have said it is old age and never connected it to statins.

Dirkdj - a few weeks ago I flew my aircraft and it rained. The next day I didnt fly and it was sunny. So I sold my aircraft because it makes it rain.

Sorry, but your ATC problems were not due to statins. How do we know? Because objective research on thousands of patients has shown it doesnt happen.

Pace - first we had dodgy doctors, now you are claiming there is shady research. The only shady elements are to do with quacks and alternative medicine. Research is highly regulated by ethics committees. You are talking rubbish.

Yes drug companies do exist to make profits and put themselves first. A few years perhaps the best anaesthetic drug in use was pulled because the drug company wanted the plant to make an antibiotic which was more profitable. I am no excusnik for the pharmaceutical industry. BUT without chemists, drug companies and engineers, medicine would still be chopping off legs on the unanaesthetised. There would be no diagnostics and no cancer treatment.

In fact patent law has changed so that the time a pharmaceutical company has to make a profit is so limited they want high profits per unit dose and mass uptake - having someone on a drug long term is little use as it will come off patent